Wheeled mobility devices include, but are not limited to manual wheelchairs (e.g. standard, heavy duty, lightweight, ultra lightweight),  powered wheelchairs, motorized wheelchairs or  power operated vehicles (scooters) Wheelchairs are generally used by adults or children with neurological, orthopedic, or cardiopulmonary conditions.  The appropriate type of wheelchair is determined according to the individual's body size (e.g., pediatric, bariatric, and adult wheelchairs) and medical needs (e.g., spasticity, contractures, cardiopulmonary, postural deficits, etc.). Wheelchair accessories and options are available for those individuals with specific medical needs related to mobility. This document addresses criteria related accessories and options.

Note: Please see the following related documents for additional information:

• CG-DME-24 Wheeled Mobility Devices: Manual Wheelchairs–Standard, Heavy Duty, Lightweight
• CG-DME-31 Wheeled Mobility Devices: Wheelchairs–Powered, Motorized, Power Operated Vehicles (POVs) and Power Seating Systems
• CG-DME-33 Wheeled Mobility Devices: Manual Wheelchairs–Ultra Lightweight

Medically Necessary:

Options/accessories for the following types of wheeled mobility devices:

• Manual Wheelchairs–Standard, Heavy Duty, Lightweight, Ultra Lightweight; AND
• Wheelchairs–Powered, Motorized, Power Operated Vehicles (POVs) and Power Seating Systems

are considered medically necessary when:

• The wheelchair itself is considered medically necessary; AND
• The options or accessories are necessary for the member to function in the home and perform the activities of daily living.

The following table lists some options/accessories and the medically necessary criteria:

Repairs and replacements for wheelchair options/accessories are considered medically necessary when:

• Needed for normal wear or accidental damage;
• The changes in the individual's condition warrant additional or different options/accessories, based on clinical documentation.

Not Medically Necessary: 

Wheelchair options/accessories are considered not medically necessary for any of the following:

• When their features are generally intended for use outdoors;
• An option/accessory which exceeds that which is medically necessary for the member's condition;
• Options/accessories used as backups for current options/accessories or anticipated as future needs;
• Options/accessories that allow the member to perform leisure or recreational activities. The following are some examples of comfort, luxury or convenience items:
  • Mobility assistive device rack for automobiles;
  • Support frames for cellular phone/CDs/etc.;
  • Auto carrier - car attachment to carry assistive device;
  • Lifts providing access to stairways or car trunks;
  • Transit options, tie-downs;
  • Baskets/bags/backpacks/pouch - used to transport personal belongings;
  • Towing package;
  • Crutch and cane holder;
  • Prefabricated plastic or foam vest type trunk support designed to be worn over clothing and not attached to an assistive device;
  • Trunk loader - assists in lifting the assistive device into a van;
  • Cup holders;
  • Prefabricated plastic-frame back support that can be attached to an assistive device but doesn't replace the back;
  • Upgrading for racing or sports;
  • Firearm/weapon holder/support;
  • Ramps – used to allow entrance or exit from the home;
  • Frame/holder for ice chest;
  • Snow tires for the assistive device;
  • Seat lift mechanisms;
  • Van modifications, van lifts, hand controls, etc. that allow transportation or driving while seated in the manual wheeled mobility device.

Modifications to the structure of the home environment to accommodate any options/accessories (e.g., widening doors, lowering counters) are considered not medically necessary.

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. 

This guideline is based on the Centers for Medicare and Medicaid Services (CMS) Mobility Assistive Equipment National Coverage Decision (NCD), which considers the clinical indications for the appropriate types of mobility assistive devices as well as options/accessories for these devices.

Mobility impairments include a broad range of disabilities that affect a person's independent movement and cause limited mobility. According to the National Center for Medical Rehabilitation Research, an estimated 25 million people have mobility impairments, which may take the form of paralysis, muscle weakness, nerve damage, stiffness of the joints, or balance/coordination deficits. About two million of these individuals use wheelchairs.

Selecting wheelchair options/accessories is individualized and must consider the user's impairment, level of function, surrounding environment, activity level, seating and positioning needs.

Activities of daily living (ADLs): Self care activities such as transfers, toileting, grooming and hygiene, dressing, bathing, and eating.

Functional Mobility: The ability to consistently move safely and efficiently, with or without the aid of appropriate assistive devices (such as prosthetics, orthotics, canes, walkers, wheelchairs, etc.), at a reasonable rate of speed to complete an individual's typical mobility-related activities of daily living; functional mobility can be altered by deficits in strength, endurance sufficient to complete tasks, coordination, balance, speed of execution, pain, sensation, proprioception, range of motion, safety, shortness of breath, and fatigue.

Peer Reviewed Publications:

1. McLaurin CA, Axelson P. Wheelchair standards: an overview. J Rehabil Res Dev Clin Suppl. 1990; (2):100-103.

Government Agency, Medical Society and Other Authoritative Publications:

1. Centers for Medicare & Medicaid Services. National Coverage Decision (NCD) for Mobility Assistive Equipment (MAE) NCD# 280.3. Effective May 5, 2005. Available at: http://www.cms.hhs.gov/mcd/index_chapter_list.asp. Accessed on January 4, 2011.
2. National Institute on Disability and Rehabilitation Research. Available at: http://www.ncddr.org/new/announcements/nidrr_brochure.html.  Accessed on January 4,, 2011.

Wheelchair options/accessories

The use of specific product names is illustrative only.  It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.